According to a new study, screening all adults for hepatitis C (HCV) is a cost-effective way to improve clinical outcomes of HCV and identify more infected people compared to current recommendations. Using a simulation model, researchers from Boston Medical Center, Massachusetts General Hospital (MGH) and Stanford University found that this expanded screening would increase life expectancy and quality of life while remaining cost-effective.

​The Centers for Disease Control and Prevention (CDC) currently recommends HCV testing for people born between 1945 and 1965, the highest risk population in the U.S. However, recent trends have shown a higher incidence rate of HCV among young people. To address this gap in testing, the researchers created simulations to estimate the effectiveness of HCV testing strategies among different age groups. They compared effects of the current testing recommendations; of testing people over 40 years old or over 30 years old, and of testing all adults over 18 years old. All strategies included the current recommendations for targeted testing of high-risk individuals, such as people who inject drugs.The study found that screening all adults for would identify more than 250,000 additional people with HCV, increase cure rates from 41 to 61 percent, and reduce death rates for HCV-attributable diseases more than 20 percent, compared with current recommendations.The Centers for Disease Control and Prevention (CDC) currently recommends HCV testing for people born between 1945 and 1965, the highest risk population in the U.S. However, recent trends have shown a higher incidence rate of HCV among young people. To address this gap in testing, the researchers created simulations to estimate the effectiveness of HCV testing strategies among different age groups. They compared effects of the current testing recommendations; of testing people over 40 years old or over 30 years old, and of testing all adults over 18 years old. All strategies included the current recommendations for targeted testing of high-risk individuals, such as people who inject drugs.The study found that screening all adults for would identify more than 250,000 additional people with HCV, increase cure rates from 41 to 61 percent, and reduce death rates for HCV-attributable diseases more than 20 percent, compared with current recommendations.TO CONTINUE READING STORY:​https://medicalxpress.com/news/2018-02-hepatitis-adults-cost-effective-outcomes.html

​ ALBANY, NY -- On Monday, February 12th, New York State Medicaid Director Jason Helgerson made news by announcing a potential path forward in the State’s response to its major hepatitis C epidemic at the joint Senate/Assembly budget hearing on Health and Medicaid. “We already have statutory authority to look at volume based discounts [for hepatitis C treatment],” Helgerson said in response to a question about improving New Yorkers’ access to hepatitis C treatment from ranking Senate Health Committee Member Senator Gustavo Rivera. “One of the things we’re going to do is—once the prices stabilize—is to look at possibly utilizing that statutory language to see if we can’t get ourselves an even lower price, which makes it even easier for us to actively promote the treatment.”

Volume based discounts on hepatitis C treatment could significantly increase the number of New Yorkers being cured of hepatitis C. This strategy is not a first for New York. Volume based discounts for Truvada for PrEP allowed the State to greatly expand access to this HIV prevention medication and put New York at the forefront of the national effort to end HIV as an epidemic.

Advocates for improved treatment access say that a similar volume based discount deal for hepatitis C cures could more than double the number of people cured of hepatitis C per year at the same cost to the State. “Right now there is a tremendous opportunity for both New York and treatment manufacturers to negotiate a deal to lay the groundwork for the statewide elimination of hepatitis C,” said Annette Gaudino, HCV/HIV Project Co-Director at the Treatment Action Group. “Manufacturers have the unique opportunity to gain market share and the State has the opportunity to cure more people at lower prices.”

"Hepatitis C is a curable disease and New Yorkers who have it should have access to every resource the State can offer," said State Senator Gustavo Rivera. "Following an informative exchange at Monday's hearing, I am thrilled to work with Medicaid Director Jason Helgerson to ensure that we make these necessary medications more affordable. Thanks to advocates like VOCAL-NY and COPE, New York will continue to be at the forefront of treatment-centered approaches to cure more people and prevent unnecessary deaths."

“New York should take an aggressive tact in negotiating hepatitis C drug costs. As more competition enters the market, we should be working with these drug manufacturers to develop a purchasing agreement that allows for an expansion of treatment for New Yorkers. We are in a position to eradicate this disease and stop a growing epidemic,” said Assemblyman Ken Zebrowski, who was a leader in passing the State’s Hepatitis C Testing Law in 2013.Hepatitis C treatment prices have already dropped significantly with the entry of the Merck & Co. drug Zepatier and the AbbVie Inc drug Mavyret into a market that had been dominated by Gilead Sciences. Merck has already offered an initial volume based discount deal that is being considered by the State.

The ambitious and achievable goal to cure every New Yorker living with hepatitis C is the key objective of the NYS Hepatitis C Elimination Campaign. As of this year, one hundred forty-seven hospitals, community health centers, and local departments of health endorsed NYS Hepatitis C Elimination Consensus Statement, calling on Governor Andrew Cuomo, the NYS Legislature, and industry partners to make a joint commitment to hepatitis C elimination, with a formal Task Force to establish a statewide elimination plan. The World Health Organization and the National Academy of Sciences have recently published feasibility studies and strategies endorsing the goal of hepatitis C elimination.

However, the national data show a deepening hepatitis C crisis. Last year, the U.S. Centers for Disease Control and Prevention (CDC) put out a report showing that the number of new hepatitis C infections reported to CDC nearly tripled between 2010 and 2015, reaching a 15-year high. The national increase in prescription opioid and heroin injecting has been linked to the increase in new hepatitis C infections. Another recent CDC report warned that hepatitis C is killing more Americans than the combined deaths of 60 other infectious diseases, including HIV.

“Not treating people with hepatitis C puts them in greater risk for liver cancer. We are seeing these rates rising,” said Ronni Marks, patient and founder of the Hepatitis C Mentor and Support Group.

Gail Brown, Coalition for Positive Health Empowerment (COPE), added, “It’s criminal that New York State has not already committed to eliminating hepatitis C. We have a known cure and considerably lower drug prices. Instead of taking advantage of this unique opportunity to pave the way for other states, New York is waiting for people to die.”

“It’s very encouraging to hear about these developments. But we also need the State Legislature to appropriate funds this year to build network capacity for outreach, prevention, hepatitis C treatment and treatment support,” said Charles King, President & CEO of Housing Works.

In New York State, approximately 280,000 people have been infected with hepatitis C, half of whom are unaware of their status. There were nearly 15,000 new hepatitis C cases in 2016, roughly five times more new hepatitis C cases than the number of new HIV diagnoses reported in the same year. Even with easy-to-take and extremely effective curative treatments on the market for the past seven years, approximately 1,000 New Yorkers still die annually from hepatitis C related causes.

I have heard that some providers and others are questioning if there is still a need for Hepatitis C support groups. While I agree these groups are no longer needed for hand holding purposes as they were in the interferon era, they now have taken on a new look. These are some of the reasons I believe there is still a very important role for these groups.

As I travel the country training people, I see the lack of education about Hepatitis C, both from patients, as well as providers, particularly in rural areas. This is why I now refer to them as Educational Support Groups. For those of us who experienced treatment before the DAA’s, the side effects of today are minimal. But for those who are treatment naïve, for some, side effects exist. While the treatments may be for a shorter time, some patients still need help in dealing with having Hepatitis C. Some patients return to groups stating that they are experiencing physical and psychological issues post treatment. Even after cure, some are not aware that they need to be followed up with an Ultra sound every six months (F-3 or cirrhosis) as they may still be at risk for Liver Cancer. These are some of the things patients have told me they have learned by attending a group not from their provider.For those aware there is a cure, but have no access to treatment due to restrictions, this has impacted them psychologically. They feel “stigma” now more than ever. I have had a patients express to me that it makes them feel "unworthy". This is heartbreaking. For those who do not have access right now, it is a good source for how one can maintain their health while awaiting treatment. For those who have cured, ensuring they stay cured and healthy. When working with people who inject drugs, I have heard too many times that they are not aware that they can become REINFECTED once cured. This message must be heard loud and clear. Many are not aware that the virus lives on equipment.There is a generation of young people who have become infected with Hepatitis C through use of injecting opioids and heroin sharing needles. More education in regard to transmission should be included in these groups. Some in the LGBTQ community are sharing needles for hormones and steroids. There is also a growing consensus that sex is a leading cause of new HCV infections among men who have sex with men (MSM), especially those who have HIV. We need to be educating them.Women of child bearing age need to be educated on vertical transmission of Hepatitis C. Support groups can be a good source to find patients who may want to become advocates for their own health, as well as for others who cannot speak for themselves. Part of the group can be demonstrations to patients on the few easy steps it takes to call their local and state politician’s office to help educate them on Hepatitis C. It is a good way to show patients how their voice matters!I strongly urge those who are looking for education and support to join a group whether it is on line, in person, or thru tele-support.

AbstractBackgroundThe U.S. Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend one-time hepatitis C virus (HCV) testing for persons born 1945-1965 and targeted testing for high-risk persons. This strategy targets HCV testing to a prevalent population at high risk for HCV morbidity and mortality, but does not include younger populations with high incidence. To address this gap and improve access to HCV testing, age-based strategies should be considered.MethodsWe used a simulation of HCV to estimate the effectiveness and cost-effectiveness of HCV testing strategies: 1) standard of care (SOC) – recommendation for one-time testing for all persons born 1945-1965, 2) recommendation for one-time testing for adults ≥40 years (≥40 strategy), 3) ≥30 years (≥30 strategy), and 4) ≥18 years (≥18 strategy). All strategies assumed targeted testing of high-risk persons. Inputs were derived from national databases, observational cohorts and clinical trials. Outcomes included quality-adjusted life expectancy, costs, and cost-effectiveness.TO READ: ​https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciy098/4840186?redirectedFrom=fulltext

Results of a recent study showed a significant correlation between the increase of acute hepatitis C cases in the U.S. and the country’s current opioid epidemic. Acute HCV and admissions for opioid injection drug use increased significantly among individuals aged 18 years to 39 years, both men and women, and specific ethnicities.“Substantial increases in the number of persons with opioid use disorders who inject drugs have the potential to thwart the nation’s efforts to control morbidity and mortality associated with HCV infection, consequently undermining the National Academies of Sciences, Engineering, and Medicine’s national strategy for the elimination of hepatitis B and C,” Jon E. Zibbell, PhD, from the Behavioral and Urban Health Program, Georgia, and colleagues wrote. “It also challenges the Centers for Disease Control and Prevention’s Viral Hepatitis Strategic Plan for 2016 to 2020, which underscores reductions in HCV infections caused by [injection drug use] behaviors as a priority area.”Zibbell and colleagues analyzed Treatment Episode Data Set (TEDS) admissions from the Substance Abuse and Mental Health Services Administration (SAMHSA) and laboratory-confirmed cases of acute HCV with associated demographic and risk factors from the National Notifiable Disease Surveillance System.Acute HCVThe researchers found 12,953 acute HCV cases reported between 2004 and 2014 in the U.S. The annual rate increased from 0.3 cases per 100,000 in 2004 to 0.7 cases per 100,000 in 2014 (P < .001) for an overall rate increase of 133%.

TO CONTINUE: https://www.healio.com/hepatology/hepatitis-c/news/online/%7B41b900ea-947e-4cce-a9d6-5cee40f9c279%7D/increases-in-acute-h

Annual opioid fatalities have now surpassed the yearly number of deaths from AIDS at the height of that epidemic in the mid-1990s. In 2016 drug overdose deaths numbered 63,000, more than the U.S. death toll from the entire Vietnam War. The trend is terrifying: the problem is getting worse each year.Cities and states reeling from opioid deaths need to give serious consideration to setting up safe injection rooms, which could significantly reduce fatalities. These are places where a drug user can go to consume illegal drugs under the supervision of health workers. They have been used in Europe, Canada and Australia for decades, and evidence and experience there shows they are very effective. This may not seem like an obvious way to fight an abuse epidemic, but there are few other options. While in the U.S., many cities’ efforts to establish such sites have stalled, Philadelphia is now poised to open the country’s first officially sanctioned safe injection site.The misuse of prescription opioids such as OxyContin is inextricably linked with that of street drugs such as heroin. Nearly half of young people who inject heroin started by abusing prescription drugs. Then they turned to the cheaper, more readily available alternative. The path from pills to needles has meant that U.S. deaths from heroin have increased by a factor of five since 2010, topping 15,000 people in 2016. The number of dead is continuing to climb as people overdose on heroin laced with fentanyl, a synthetic opioid that makes heroin much more potent—and thus more deadly.That’s where safe injection sites would come in. At more than 90 such locations in Europe and elsewhere, if someone overdoses at one of these sites, a health worker or other first responder quickly administers an antidote. The injection facilities also have proved they can reduce the transmission of blood-borne infections, partly through needle-exchange programs. They can also save money: in San Francisco, for example, one analysis concluded that for every dollar spent on such sites, $2.33 in emergency medical, law enforcement and other costs would be reduced, producing a yearly net savings of $3.5 million.

Effective antiretroviral treatments for HIV and hepatitis C exist and are widely available. In fact, treatment for hepatitis C is curative, which hardly seemed imaginable only a few short years ago. But despite there being effective treatments for these diseases, barriers exist that make their treatment difficult. Chief among these barriers is intravenous use of opioids.The stark reality is that people with hepatitis C or HIV, or both diseases, are much more likely to die of drug overdose than of chronic illness itself. Furthermore, according to the Centers for Disease Control and Prevention, in 2014 death from drug overdose was more common than death caused by motor vehicle accidents or firearms. Of note, 80% of people who inject drugs and are HIV-positive also have hepatitis C.At IDWeek 2017, managing infectious disease in opioid users was an important topic of coverage. In a lecture titled "Co-management of Opioid Treatment, HIV, and Hepatitis C Treatment," Brianna Norton, DO, MPH, an assistant professor of infectious disease and internal medicine at the Albert Einstein College of Medicine, discussed evidence-based approaches to treating opioid use disorder in patients with HIV and hepatitis C.[1]The Austin, Indiana, OutbreakIn late 2014, an HIV outbreak was centered on a small rural town called Austin, in Scott County, Indiana. Austin is about 80 miles southeast of Indianapolis. Although Austin has a population of approximately 4200, by June 2015, 170 people had been diagnosed with HIV infection. To put this number in perspective, during the 10 years before the outbreak, only 5 people had been diagnosed with HIV in Scott County.[2]In a 2016 article titled "HIV Transmission and Injection Drug Use: Lessons From the Indiana Outbreak," Diane M. Janowicz, MD,[2] attributed this HIV outbreak to injection drug use. "It is estimated that there were more than 500 syringe-sharing partners in Scott County. Injection practices were multigenerational and injection equipment was commonly shared. Individuals diagnosed with HIV infection during the outbreak had an average of nine high-risk syringe-sharing, sex, or social partners who needed to be tested for infection. The drug most commonly used was oxymorphone, in a reformulation available since 2012, which was crushed and injected. Oxymorphone produces a fixed but short-lived high, and individuals may inject the substance as many as 20 times per day."

.As many as three-quarters of individuals with hepatitis C virus (HCV) experience disorders related to the virus beyond the impact on their livers, the National Viral Hepatitis Roundtable estimates.

HCV-related kidney disease, depression, skin disorders, lymphoma and other conditions can seriously impact a patient, even without severe damage to the liver, studies have shown. There’s also growing evidence as to how HCV intersects with other disease states, Tina Broder, MSW, MPH, Program Director of NVHR, told MD Magazine.

“Our hope in highlighting the extrahepatic manifestations of HCV is to show that curing HCV patients may help improve health conditions beyond liver function,” Broder said.

To publicize that point, NVHR is creating a campaign aimed at both clinicians and patients that emphasizes the importance of managing the virus as a system-wide condition. The group is distributing informational “fact sheets” produced from a review of scientific research and input from staff and a clinical consultant with expertise in HCV. The aim is to help make a business case for treating patients regardless of the severity of their liver disease and to broaden treatment access, Broder said.As many as 3.9 million people in the US have chronic HCV, the US Centers for Disease Control and Prevention (CDC) estimates. Of every 100 individuals infected with the virus, 75 to 85 of them will develop chronic HCV. Five to 20 of these patients will progress to cirrhosis in 20 to 30 years. As many as 5 will die from cirrhosis or liver cancer, the CDC estimates.Hepatitis C-related effects on parts of the body besides the liver can be an early indicator of HCV infection, NVHR says. And the virus may be driving other chronic conditions that primary care providers must spend their time managing.“The evidence showing that HCV infection is a risk factor for other health conditions continues to grow,” Broder said. “Concurrently, research is beginning to show that in the era of direct acting antivirals (DAAs), early HCV treatment can cure and possibly prevent the development of extrahepatic manifestations associated with HCV.”​​TO CONTINUE READING: https://www.specialtypharmacytimes.com/news/growing-evidence-shows-hepatitis-c-intersects-with-other-diseases

More than 60 organizations, including NVHR, signed onto a letter urging the Trump administration to invest in the Department of Health & Human Services Viral Hepatitis Action Plan and to commit in words and action to the elimination of HBV and HCV in the United States by 2030. You may download a copy of the letter here.

Less than 10 days before Christmas, another Santa Clarita Valley family lost a son to the heroin epidemic.It wasn’t an overdose, but a growing concern that’s associated with the drug epidemic. The 29-year-old died of endocarditis, which, like the Hepatitis B he’d also contracted, was brought on by intravenous drug use.He’d been arrested several times, and like many who are addicted to drugs in the Santa Clarita Valley, he was known to the Santa Clarita Valley Sheriff’s Station’s Juvenile Intervention Team, or J-Team, which had tried repeatedly to get him into a rehab program.“In June, I had contacted the guy and he was very cordial, we had a very cordial conversation and I offered him our help in finding a drug counseling program that would fit his financial situation,” said Sgt. Bob Wachsmuth, a drug addiction specialist and member of the Santa Clarita Valley Sheriff’s Station’s Juvenile-Intervention Team, or J-Team. “And he said he would get back to me.”Relapses and repeated use bring with them a myriad of concerns and medical problems beyond the deadly overdose.“Using drugs themselves, obviously are pretty dangerous,” said Dr. Darrin Privett, an emergency room doctor for Henry Mayo Newhall Hospital, “but on top of that there’s a host of complication that can make that even more dangerous.”The most common things that emergency room doctors see are the painful infections that addicts can get from intravenous drug use, he said.“Most commonly they get local abscesses where they inject in the skin,” he said. “The veins themselves get inflamed and scarred.. and then there are other associated diseases, such as Hepatitis B, Hepatitis C and HIV.”Studies have shown that 75 percent to 90 percent of people who inject drugs have Hepatitis C, he pointed out.